NCPA - National Center for Policy Analysis


January 23, 2007

Doctors have recommended forcibly detaining people in South Africa who refuse treatment for a drug-resistant form of tuberculosis, an extreme measure meant to keep the infected away from others to curb the spread of the disease, according to a paper published in the Public Library of Science Medicine medical journal.

Since detecting extensively drug-resistant tuberculosis, also known as XDR-TB, in South Africa last year, health officials have called for increased measures to combat the strains, including better surveillance, diagnostics and drugs.

In their paper, physicians Jerome Amir Singh, Ross Upshur and Nesri Padayatchi propose that XDR-TB patients who refuse treatment be involuntarily detained in hospitals or other health care facilities:

  • In the 1990s, New York City health authorities authorized the forcible detention of people who rejected TB treatment, some for as long as two years, ultimately leading to a significant dip in cases; the detainees were held in Bellevue or Goldwater hospitals.
  • Last September, the World Health Organization announced there were 53 confirmed XDR-TB cases in South Africa, of which 52 were fatal (most of the patients were also HIV positive); to date, more than 300 cases have been identified, and at least 30 more are picked up each month.

Though extensively drug-resistant tuberculosis exists worldwide, including in Eastern Europe, Russia and the United States, Africa's high number of HIV/AIDS patients makes it particularly worrying. Not only does HIV/AIDS fuel the spread of tuberculosis, but infection with both HIV/AIDS and XDR-TB means an almost certain death. Weak African health systems lack the means to treat XDR-TB patients, for whom the only drugs that might work are much more expensive than regular TB drugs.

Source: "Doctors Say It Might Be Necessary to Detain TB Patients," Associated Press/Wall Street Journal, January 22, 2007; based upon: Jerome Amir Singh, Ross Upshur and Nesri Padayatchi, "XDR-TB in South Africa: No Time for Denial or Complacency," Public Library of Science Medicine, January 23, 2007.


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